Nasal hyperreactivity in rhinitis: A diagnostic and therapeutic challenge

Abstract

Although nasal hyperreactivity (NHR) is a common feature in patients suffering from allergic and nonallergic rhinitis, it is widely neglected during history taking, underdiagnosed in the majority of patients with rhinitis and rhinosinusitis, not considered as an outcome parameter in clinical trials on novel treatments for rhinitis and rhinosinusitis, and no target for routine treatment. In contrast to the simple nature of diagnosing NHR by a history of nasal symptoms induced by nonspecific exogenous and/or endogenous triggers, quantification is hardly performed in routine clinic given the lack of a simple tool for its diagnosis. of NAR. In this recent publication, 5 the pathophysiology of IR was studied rather than the prevalence and the inclusion criteria for IR were stricter than for NAR which explains the lower patient

Bronchial asthma triggered by house dust mites in patients with local allergic rhinitis

“…Half of the MT+ LAR individuals did not experience a positive BPT‐DP, implying that in those patients, the nasal allergen sensitivity coexists with unspecific AHR. This finding is not surprising, as unspecific nasal and bronchial hyperresponsiveness can be present in many respiratory conditions including allergic airway disease . Of note, the vast majority of AA and LAA individuals were MT+ before the BPT‐DP.…”

Safety and reproducibility of nasal allergen challenge

“…During the visit when the NAC was scheduled, a nasal endoscopy was conducted as a baseline evaluation, and in order to exclude anatomical and inflammatory disorders. Before the application of the allergen solution, all individuals were subjected to a bilateral nasal challenge with 100 μL of isotonic saline serum in order to rule out nasal hyperreactivity (NHR) . The patients displaying two consecutive positive saline challenges (read NAC monitoring ) with a minimum interval of 2 weeks were excluded from further NAC attempts.…”

A Precision Medicine Approach to Rhinitis Evaluation and Management

“…Capsaicin did not alter nasal epithelial morphology nor did it induce apoptosis or necrosis in cultured human nasal epithelial cells and mast cells [53]. Since many years, the use of azelastine has been found to be effective in NAR patients, but only recently, azelastine has been demonstrated to exhibit TRPV1 channel activity through the modulation of Ca2+ signaling on sensory neurons and in nasal epithelial cells [83].…”